AN AUDIT OF DERMATOLOGY IN A PEDIATRIC ACCIDENT AND EMERGENCY DEPARTMENT

Two studies were undertaken of patients with dermatological disorders who attended the Accident and Emergency (A&E) Department of the Royal Belfast Hospital for Sick Children during 1990-1991. The aims were to review diagnostic accuracy and assess the benefits of an open-access c onsultant dermatology clinic. A retrospective survey of 14340 new atte ndances at the A&E department over a 7-month period found that 540 of these (4%) had a primary dermatological disorder. In 26% no diagnosis had been made although only 10% were referred for a specialist opinion . A 2-month prospective study of patients who attended the department and were referred to a consultant dermatology open-access clinic revea led overall diagnostic accuracy of 66% (+/- 2 SEM). Individual rates o f diagnostic concordance between junior doctor and consultant were 59% for skin infections and 77% for papulosquamous disorders. The open-ac cess clinic allowed prompt referral for correct diagnosis and initiati on of appropriate management.